I first visited Cuba 20 years ago and was struck by how healthy the children looked, despite the fact that the country was poor, buildings were falling down, and goods were in short supply. I have been fortunate to visit Cuba and its health institutions many times since. This has given me an insight into how they have achieved world renowned health indicators while suffering the deprivations bought about by decades of an illegal US blockade.
Sadly the extra sanctions imposed on Cuba in recent years, including the inclusion in the US ‘State Sponsors of Terrrorism’ list threaten these gains, which is why we need to support the Cuba Vive Medical Aid Appeal.
Cuba has a holistic approach to health and a strong primary health care system focussing on the prevention of disease. Almost half of all Cuban doctors are family doctors (similar to a GP). Each family doctor works with a nurse providing healthcare to 300-350 families. They know each family medically and socially, recognising the link between health and the social environment.
In Cuba pregnant teenagers have the option to stay in a maternity home during their pregnancy. In a country where housing is overcrowded, the opportunity to receive free accommodation and healthy meals, nutritional advice, and medical support is usually welcomed. This approach results in fewer small and premature babies and gives babies the best possible start in life.
Programmes such as these helped to significantly reduce infant mortality in Cuba which in 2019 was one of the lowest in the Americas at 5 per thousand live births. In the aftermath of the COVID-19 pandemic and increasing shortages in the health sector, this has risen to 7.5 per thousand.
Since US companies won’t sell to them, Cuban doctors are forced to adapt larger catheters to use for infants with renal failure who need dialysis; many of the 450 Cuban children diagnosed with childhood cancer each year are forced to go without the appropriate drugs; and 20,000 Cuban families waiting for diagnoses of genetic diseases have not been able to receive adequate care because the technology needed to treat them contains over ten per cent US components and therefore can’t be sold to Cuba.
In Cuba family doctors and hospital services work together, encouraging early discharge and more community care. There is no competition between healthcare providers in Cuba, unlike the UK where time and money is wasted by introducing a market economy into healthcare. There is an extensive immunisation service reducing many diseases. Cuba is the only country to have vaccinated all children over 2 years-old with home produced COVID vaccines. But US sanctions delayed access to the raw materials to produce these life-saving medicines. In a 2021 report, Oxfam, the international development charity said“For over a year, these sanctions have represented a real obstacle to the procurement of mechanical ventilators, face masks, diagnostic kits, reagents, vaccination syringes, and other necessary materials to address COVID-19.”
International suppliers regularly cancel contracts for supplies to the Cuban pharmaceutical industry. In 2022, 67 US pharmaceutical firms refused or did not respond to MediCuba’s requests for medicines for cancer and stroke patients in Cuba.
Cuba has trained its own doctors and other health professionals by providing free education from school to university. They have a higher doctor to patient ratio than the UK and most other countries. However, Cuba’s dedicated health professionals struggle with limited resources to treat patients. From surgical supplies to spare parts, paracetamol to sutures: items that are in plentiful supply in the UK, are increasingly hard to come by or cost up to three or four times more in Cuba due to the US blockade.
I have been struck by the humility of Cuban health professionals who work in difficult circumstances. They provide excellent caring healthcare, despite the lack of medicines and equipment, due to the inhumane blockade which cost the Cuban health sector more than $240 million from March 2022 to February 2023 alone.
Cuba is also training doctors from deprived communities in many countries in Cuba. The Latin American School of Medicine in Havana is the ONLY medical school in the world providing this free education. Cuba’s continued inclusion on the US State Sponsors of Terrorism list threatens Cuba’s ability to continue its international health programmes as well as provide health care for its own population.
I welcome the Cuba Vive appeal launched by the Cuba Solidarity Campaign and UNSION regions in January 2024 which aims to raise money to buy and send containers of life-saving medicines, surgical and other vital medical aid to Cuba. I will be supporting it and hope you will too.
Imti Choonara is Emeritus Professor in Child Health, University of Nottingham
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